Research Highlights

Massage and Cancer: Supporting Patients and Caregivers

A massage can be a relaxing treat
after stressful events, or a nice quick
rehabilitation for sore or tight muscles.
It can also be a hands-on therapy that
provides supportive care for cancer
patients and their caregivers, relieving
more than just stress and tight muscles.
Massage can help reduce pain, fatigue,
nausea, and other symptoms often
suffered by cancer patients and survivors.
The benefits are not exclusive to massage
recipients – those giving the massage can
also feel greater levels of confidence in
their ability to help their loved one cope
with cancer.

William Collinge, Ph.D., M.P.H.,
LCSW, is the owner of Collinge and
Associates, an independent research
and consulting organization funded by
research grants from the NIH and other
sources. He also runs a private practice
focused on cancer survivorship located in
Eugene, Oregon.

Dr. Collinge’s work was funded by the
Small Business Innovations Research
(SBIR) Grant mechanism (R43/R44).
SBIR grants are awarded to domestic,
for-profit, small businesses to conduct
innovative research and development
that has potential for commercialization
and public benefit. Dr. Collinge was
awarded an SBIR grant* to study how
touch and massage, used as supportive
care and guided by a multimedia
instructional program, could affect
patient symptoms and side effects,
patient quality of life, and caregiver
attitudes toward touch as a form of
caregiving. Collinge and Associates
created the DVD used in the multimedia
instruction program titled, Touch, Caring
and Cancer: Simple Instruction for Family
and Friends. The goal of the DVD was
to allow family members to become part
of a treatment team for a cancer patient.
Using massage and simple touch, both
the patients and caregivers could receive
benefit. The video provided 78 minutes
of instruction by Collinge and two
oncology massage therapy researchers
and was filmed with live patientcaregiver
pairs. A 70-page illustrated
manual accompanies the DVD and is
designed to teach caregivers techniques
for relaxation, acupressure, and simple
light touch. The DVD and manual are
intended for use at home by patients and
caregivers and are available in English,
Spanish, and Chinese (Mandarin and
Cantonese).

Dr. Collinge conducted a randomized
controlled trial of a multi-ethnic sample
of 97 adult caregiver-patient pairs. Pairs
were randomized to either the treatment
or control group. Pairs in the treatment
group met with other subjects, viewed
the instructional DVD together, and were
then given a copy of the DVD plus data
collection materials. The participants
were encouraged to view the materials
of both the DVD and manual as often
as they liked and practice the techniques
of their choice three times per week,
with a suggested duration of 20 minutes.
However, pairs were told that as little as 5
minutes could be beneficial.

The control group acted as an attention
control which required caregivers to
read to the patients at least three times
per week with a suggested duration of
20 minutes, but were told as little as 5
minutes would be beneficial. Reading
material could be of any type of literature
of the patient’s choice. Control group
participants were allowed to join the
intervention after 4 weeks and all subjects
were followed for another 16 weeks.

Both the treatment and control groups
were to report on session effects for one
session each week as they related to the
pre-and post-session severity levels for
pain, fatigue, stress/anxiety, nausea,
and depression, and an optional other
category. The caregivers in each group
also filled out surveys to assess their stress
levels and feelings towards caregiving.
Results showed significant reductions for
all symptoms after both the treatment
and control group activities. Pain reduced
18% in the control group and 34% in
the massage treatment group. Fatigue
was reduced 20% vs. 32% (reading vs.
massage); stress/anxiety, 28% vs. 44%;
nausea, 12% vs. 29%; depression 22% vs.
31%; and other symptoms 17% vs. 42%.
Massage was shown to be significantly
superior to reading for stress/anxiety,
pain, fatigue, and other symptoms.
Both groups of caregivers had significant
increases over the 4 weeks in satisfaction
with their ability to help their partners
feel better, and they had reduced concern
about causing distress. Results have
been published in Journal of the Society
for Integrative Oncology**, Seminars in
Oncology Nursing***, and another article
about the research is currently under
review.

Dr. Collinge notes that he wanted to
pursue this area of research because he “saw a need for caregivers to be able to
offer something tangible to benefit the
well-being of their loved ones with cancer.
Caregivers experience distress from a
perceived inability to reduce suffering in a
loved one. This intervention benefits the
patient, makes caregiving more satisfying
for the giver, and strengthens the quality
of their relationship, all at the same time.”
He was pleased with the results because
“informal caregivers using the techniques
were able to achieve results approaching
those of professionals. Caregivers can
easily learn safe and simple techniques
from a very low-cost multimedia
intervention. Patients can experience the
benefits of touch and massage far more
frequently than they would ever be able
to if relying on professionals. This has
huge potential for overcoming disparities
in palliative care for low-income and
underserved populations.”

This study is currently being adapted
for use in Vietnam. “The Vietnamese
version is being used at National Cancer
Hospital in Hanoi to train caregivers. We
are collecting data from sample families
in Hanoi, and it will be interesting
to see how the program might help
meet palliative care needs in an underresourced
country like Vietnam,” notes
Dr. Collinge.

In summary, this research shows that
supportive care at home can offer benefits to both patients and caregivers at
relatively low cost and effort. Caregivers’
self-efficacy about their caregiving
can be increased and patients can see
improvements in their quality of life.

Connie Dresser, RDPH, LN, Program
Director for Dr. Collinge’s grant, noted
that the project was significant because
“the study results indicate there is a good
possibility that similar outcomes could
be achieved by caregivers of patients with
other chronic diseases or depression.
Today, technology has completely taken
over how we live and the art of tangible
communication (such as face-to-face
and writing) has decreased from the
previous norms. Dr. Collinge’s work
offers a meaningful and healthy way
of reengaging with family, friends, and
patients.”

Dr. Collinge is also busy working on a
current R43 grant**** from NCI titled
“Palliative care provider online education
in evidence-based complementary
therapies.” This current research aims
to develop the first online continuing
education program for palliative care
personnel who teach evidence-based
applications of complementary therapies
in the palliative care setting. Dr. Collinge
stresses that palliative care is one of
the most rapidly expanding sectors in
health care and complementary therapies
offer significant benefits for reducing
suffering and improving quality of
life. However, there are currently no
systematic educational offerings to help
health care professionals learn how
to use complementary therapies with
diverse patient groups in the palliative
care setting. Through the R43 grant,
Dr. Collinge is working to create an
interactive website delivering educational
curricula to health care professionals
about complementary therapies and
palliative care. This is a large undertaking
that will consist of multiple reviews
of the literature, working with a team
of professionals in palliative care, and
creating and reviewing course content
and the best methods of delivery.

Dr. Collinge notes that he wanted to
do this work because “complementary
therapies are underutilized in palliative
care environments. They have a lot to
offer in terms of comfort and symptom
reduction, but practitioners need help
making evidence-based decisions. We aim
to help them sort through the strengths
and limitations of complementary
therapies in palliative care.”

Compound Found in Green Tea May Help Improve Pancreatic Cancer Treatments

Pancreatic cancers tend to be very
aggressive, with a very small percentage of
patients surviving 5 years after diagnosis.
Results of a new, NCI-supported* study
suggest there may be a new weapon in
the fight against pancreatic cancer —
one found in a very popular beverage.
Epigallocathechin gallate (EGCG)
is a component in green tea that has
anti-tumor activity in the laboratory.
Numerous studies, in a number of
different cancer types, have shown that
EGCG may decrease tumor cell growth,
increase apoptosis (programmed cell
death), and prevent formation of new
blood vessels around tumor cells.

In the current study**, researchers
investigated the effects of EGCG on
pancreatic cells. Treatment of pancreatic
cells with EGCG resulted in decreased
cell migration and increased apoptosis.
The researchers also treated cells with a
combination of EGCG and gemcitabine,
a chemotherapy drug used by pancreatic
cancer patients. The results indicated
that while EGCG and gemcitabine alone
were effective in increasing cell death and
apoptosis, the effects were greater when
the two agents were used in combination.
EGCG also enhanced the effects of
CP690550, an immunosuppressant drug
that has been shown to have anticancer
activity.

While the exact mechanisms of EGCG’s
actions on pancreatic cancer cells are
unknown, results of this study suggest
that EGCG may be interfering with
a protein — STAT3 — involved with
cancer progression. STAT3 is a member
of the signal transduction and activators
of transcription (STAT) family of
proteins, which are important for normal
cell growth. When STAT3 is activated, a
number of genes necessary for tumor cell
growth and survival are turned on. In this
study, treatment of pancreatic cancer cells
with EGCG resulted in lower levels of
STAT3 in the cells. In addition, levels of
certain genes that are turned on in cancer
and controlled by STAT3 were inhibited
following EGCG treatment.

While this initial study used an in vitro
model only, the authors noted that
their results “provide a new application
method, in which the use of EGCG
can enhance the therapeutic effects of
anticancer drugs while possibly reducing
their side effects.”

A New Report Offers Review of Research on Exercise in Cancer Survivors

An increasing amount of research
suggests that exercise may help cancer
patients feel better during treatment.
But what about when the chemo and
radiation are finally over — does exercise
help or hinder survival? A systematic
review* by Rachel Ballard-Barbash
(Associate Director of the Applied
Research Program in the Division of
Cancer Control and Population Sciences
at NCI) and her colleagues, published
in the Journal of the National Cancer
Institute, examined recent studies that
investigated the effects of physical activity
on mortality and/or cancer biomarkers in
cancer survivors.

The majority of studies included in this
review were published after 2009 and
focused on breast cancer survivors. Other
types of cancers included in the review
were colorectal, prostate, ovarian, and
brain.

Almost all of the breast cancer studies
reviewed indicated that physical activity
(before or after breast cancer diagnosis)
may be related with greater survival.
In addition, about half of the breast
cancer studies suggested a dose-response
effect — greater amounts of exercise
were associated with larger decreases in
mortality risk. There were also a number
of studies that revealed physical activity
may increase survival in colorectal
cancer survivors. There was not enough
evidence in the reviewed studies to
support a relationship between physical
activity and mortality risk for survivors
of other types of cancer.

This review also identified studies that
reported links between physical activity
and biomarkers in cancer survivors.
Among breast cancer survivors,
results of randomized controlled trials
have suggested that physical activity
may result in beneficial changes in
circulating insulin levels and insulinrelated
pathways. Results of randomized
controlled studies of survivors of other
cancer types indicated that exercise may
lead to beneficial changes in biomarkers
related to inflammation and immunity.

Although the outcomes of physical
activity seem promising, the authors of
the review note there are some caveats
that prevent them from making specific
recommendations for cancer survivors.
The studies included in this review
assessed physical activity in different ways
and reported various types of exercise.
For example, among observational
studies, the questionnaires that were used
examined participants’ physical activity
over various time points (exercise in the
past year versus exercise in the past 6
months). Among randomized control
studies, there were a variety of exercise
interventions used, including aerobic
exercise, walking, and strength training.
In addition, more cancer types should be
investigated, along with more racial and
ethnic groups. The authors of this review
concluded that while exercise may be safe
for cancer survivors and help improve
survival, “additional research is warranted
before clear conclusions can be reached
on the effects of physical activity on
disease outcomes among many groups of
cancer survivors.”